Incisional Hernia Repair: Meta-Analysis on Laparoscopic and Open Surgical Repair

Despite the benefits of laparoscopic surgery, routine laparoscopic treatment of incisional hernia remains controversial. The aim of this meta-analysis was to compare the outcomes after laparoscopic and open incisional hernia repair and to assess the advantages and limitations of these techniques. A literature search was performed from January 2006 to April 2022, using the PubMed and Scopus databases. Six randomised controlled trials, four prospective studies, and five retrospective studies were eligible; however, the meta-analysis was conducted only on the six randomised clinical trials. Laparoscopic repair was associated with a higher incidence of intraoperative complications (risk ratio calculated as open surgery/laparoscopy was 0.18 with a 95% CI from 0.06 to 0.055, p <0.05), whereas open surgery had a highly significant greater risk of surgical site infections (risk ratio calculated as open/laparoscopy was 4.47 with a 95% confidence interval from 2.16 to 9.25, p <0.001). Haematoma and seroma formation had the same rate of incidence after the two approaches. Most of the reviewed articles found a longer hospital stay in the open group, while operation time and time to oral intake did not show a significant difference between the techniques. Most of the reviewed articles suggested a higher risk of intraoperative complications in laparoscopic surgery and a lower risk of postoperative complications in laparoscopy. The recurrence rate was similar after the two approaches, but most of the studies had a short follow-up. Further studies with a longer follow-up are required. Key Words: Incisional hernia, Laparoscopic repair, Outcomes.